Drill of the Month
Developed by Gloria Bizjak
Why We Use Body Substance
Isolation Precautions
Why We Use Body Substance
Isolation Precautions
Student Performance Objective: Given information,
resources, and opportunity for discussion and practice:
– List and describe types of protective precautions.
– Define BSI precautions and explain their purpose,
importance, and requirements.
– List personal protective equipment and describe its
purpose.
– Demonstrate techniques for donning, doffing, and
disposing of PPE based on scenarios.
EMTs will follow acceptable Maryland medical practice and Maryland
Medical Protocols for Emergency Medical Providers.
Drill of the Month
2
Why We Use Body Substance
Isolation Precautions
Overview:
 Types of Protective Precautions
 BSI Precautions
 Personal Protective Equipment
 Donning, Doffing, and Disposing of PPE
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3
Types of Protective Precautions

Isolation precautions
– In-hospital isolation infection control, 1975
– Disease specific precautions to prevent
spread of infection

In-hospital precautions: patient in private

Provider precautions:
room
– Protective barriers: masks, gowns gloves
– Wash hands
– Special disposal/handling of contaminated articles
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4
Types of Protective Precautions

Isolation precautions
– Includes other precautions (discussed later)


Standard precautions
Transmission-based precautions
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5
Types of Protective Precautions

Universal precautions (UP)
– CDC 1987 (replaced CDC 1983 Guidelines
for Isolation Precautions)
– In-hospital practices to prevent transmission
of bloodborne diseases
– Emphasized that visible blood required
barrier protection
– Does not address disease-specific isolation
precautions for nonbloodborne infections
(in-hospital)
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Types of Protective Precautions

Universal precautions (UP)
– Precautions: Gloves, gowns, masks,
protective eyewear when contact with blood
or body secretions containing blood is
anticipated (not all the time as with BSI)


Applies to blood, body fluids containing visible
blood, semen, vaginal secretions
Applies to tissues and specific body fluids:
cerebrospinal, synovial, pleural, peritoneal,
pericardial, amniotic
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Types of Protective Precautions

Universal precautions (UP) continued…
– Precautions: Gloves, gowns, etc. as with
previous slide, when contact with blood or
body secretions containing blood is
anticipated


Does not apply to feces, nasal secretions,
sputum, sweat, tears, urine, vomit unless they
contain visible blood
Does not apply to saliva except when visibly
contaminated with blood or in the dental setting
where blood-contaminated saliva is predictable
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Types of Protective Precautions

Body Substance Isolation (BSI)
– Developed by nurses, colleagues working in
large hospital epidemiology departments
– Assumed all moist body substances were
potentially infectious


Not just blood as in UP
Wear gloves for anticipated contact
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Types of Protective Precautions

Body Substance Isolation (BSI)
– Purpose: Reduce transmission of infectious
material from any moist body substance
regardless of presumed infection status



Blood: HIV, HBV
Feces: shigella, salmonella, escherichia-coli
Urine: e-coli
Drill of the Month
10
Types of Protective Precautions

Body Substance Isolation (BSI) continued…
– Purpose: Reduce transmission of infectious
material from any moist body substance
regardless of presumed infection status




Sputum: tuberculosis, resistant staphylococcus
areus
Saliva: small and large droplets
Wound seepages/excretions
Other body fluids
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Types of Protective Precautions

Body Substance Isolation (BSI)
– Precautions


Gloves when anticipating contact with moist body
substances while caring for all patients
Immunization against infectious diseases
transmitted by airborne or droplet (discussed later)
–
–
–
–

Measles
Mumps
Rubella
Varicella (chickenpox)
Other appropriate barriers: gowns, masks, eye
protection
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Types of Protective Precautions

Standard precautions
– CDC 1996 for in-hospital health care providers
– Major features of UP and BSI


UP: gloves, gowns, masks, protective eyewear to
reduce risk of transmission of bloodborne
pathogens
BSI: gloves, immunization to reduce risk of
pathogens from moist body substances
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13
Types of Protective Precautions

Standard precautions
– Applied to all patients regardless of diagnosis
or presumed infection status



Blood, all body fluids, secretions and excretions
except sweat, regardless of whether or not they
contain blood
Nonintact skin
Mucous membranes
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Types of Protective Precautions

Standard precautions
–
Precautions








Consider every person infectious
Wash hands and wear gloves
Wear other body protection: masks, goggles, face masks,
gowns
Handle soiled linen with gloves; dispose of in biohazard waste
container/bags
Handle patient care equipment with gloves; clean reusable
equipment
Clean and disinfect equipment
Dispose of sharps in containers
Use face/mouthpieces, bag-valve-mask for resuscitation
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Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Airborne transmission

Small particle evaporated droplets or dust
containing droplets
– Remain suspended for a long time
– Dispersed by air currents


Inhaled by or deposited on susceptible host
Included measles, varicella, Legionella,
tuberculosis
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Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Airborne transmission precautions



Respiratory protection: High efficiency filter mask
Patient transport: Place a mask on the patient
Environmental control: Equipment cleaning,
disinfection, sterilization
Drill of the Month
17
Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Droplet transmission



Large droplet contact with conjunctiva or
oral/nasal mucosa
Droplets generated during coughing, sneezing,
talking
Requires close contact
– Large droplets do not stay suspended for long
– Large droplets travel short distance (possibly 3 feet)
Drill of the Month
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Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Droplet transmission

Precautions
– Respiratory protection: Wear a mask when within 3 feet
of patient
– Protective eyewear: With possibility of splashing, talking,
sneezing within 3 feet
– Patient transport: Place a mask on the patient
– Environmental control: Equipment cleaning, disinfection,
sterilization
Drill of the Month
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Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Contact transmission

Direct contact
– Skin-to-skin contact and physical transfer
– Touching hands, face, other body parts
 Provider-to-patient contact
 Patient-to-patient or patient-to-other person
contact
Drill of the Month
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Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Contact transmission

Indirect contact: Skin-to-object contact
– Patient’s contaminated hand touches object
– Provider touches contaminated object
Drill of the Month
21
Types of Protective Precautions

Transmission-based precautions (also include
BSI)
– Contact transmission

Precautions
– Wash hands; use gloves
– Wear a gown
– Clean and disinfect care/contact items
 After patient use/touch
 Before using on or with another patient, or use
disposable items
– Dispose of all patient contact items
 Red medical waste/biohazard containers/bags
 Sharps containers
Drill of the Month
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BSI Precautions

Definition
– A method of infection control
– Equipment, procedures to protect providers
and patients from blood and body fluids,
including airborne droplets

Purpose
– Protects patients and providers

Impossible to identify that either has an infectious
disease just by looking at them
– Prevents exposure to blood, body fluid, and
respiratory pathogens
Drill of the Month
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BSI Precautions

Need/Importance
– Patient’s full medical history is not always
available or forthcoming
– Protects providers from patients and patients
from providers
– Expands principles of UP beyond bloodborne
disease to include all moist body substances
– Presumes all body substances carry infectious
agents
– Protects providers from both bloodborne and
airborne pathogens
Drill of the Month
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BSI Precautions

Requirements
– Must meet Occupational Safety and Health
Administration (OSHA) guidelines
– Employer responsibilities



Must develop written exposure control plan
Must provide training, immunizations, and personal
protective equipment (PPE)
Must have policy for exposure to infectious
substances
– Baseline testing and periodic follow-up
– Federal legislation allows provider notification of patient
infection
Drill of the Month
25
BSI Precautions

Requirements
– Employee responsibilities


Participate in training
Follow exposure control plan
Drill of the Month
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Personal Protective Equipment (PPE)

Purpose
– Match to exposure hazard for proper protection
– Protect emergency services personnel
 From sharp, pointed, jagged objects
 From objects that may fall on your head or feet
 From body substances and includes BSI precautions
– Gloves
– Other appropriate barriers: gowns, masks, eye protection
– Immunization
Drill of the Month
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Personal Protective Equipment (PPE)

Hand washing: After patient contact when
gloves are removed
– Soap and warm water
 Lather; scrub vigorously for 20 seconds (CDC
guidelines)
– Alcohol-based hand sanitizers
 Apply to palms; rub hands together until dry (CDC
guidelines)
 Cover all surfaces of hands and fingers (CDC)
 Not effective if hands are visibly soiled
Drill of the Month
28
Personal Protective Equipment (PPE)

Gloves
– Medical grade vinyl, rubber latex, or synthetic
latex nitrile gloves
– Change if torn or damaged; wash hands;
reglove
– Use new gloves for each patient
– Dispose of gloves in biohazard waste
container/bag
Drill of the Month
29
Personal Protective Equipment (PPE)

Protective eyewear
– Protects from splashing, splattering, spraying
fluids/droplets
– Types: should cover front and sides of face
 Goggles: acceptable, but tend to fog
 Safety glasses with side shields
 Combo face shield and mask
Drill of the Month
30
Personal Protective Equipment (PPE)

Face mask or particulate respirator
– Surgical mask: Protects from blood or fluid
splatter (intubation, suctioning)
– N-95 or high efficiency particulate air (HEPA)
mask: Protects from small particle droplets,
e.g., tuberculosis
Drill of the Month
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Personal Protective Equipment (PPE)

Fluid resistant gown
– Protects clothing or bare skin from splatter
 Childbirth
 Arterial bleeding
 Multi-trauma

Pocket face mask, bag-valve-mask
– Prevents mouth-to-mouth contact
Drill of the Month
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Donning, Doffing, Disposing of PPE

Demonstrate and practice the following using
scenarios that follow
– Wash or sanitize hands
– Don PPE in proper order—why in this order?




Gown
Mask or respirator
Goggles or face shield
Gloves
Drill of the Month
33
Donning, Doffing, Disposing of PPE

Demonstrate and practice the following using
scenarios that follow
– Doff PPE in proper order—why in this order?




Gloves
Goggles of face shield
Gown
Mask or respirator
Drill of the Month
34
Donning, Doffing, Disposing of PPE

Demonstrate and practice the following using
scenarios that follow
– Dispose of PPE equipment


Sharps container
Biohazard containers/bags
Drill of the Month
35
PPE Scenarios

The patient:
–
–
–
–
–
–
A bed-ridden 72-year-old woman
Coughing up bloody sputum for the past hour
The room has an odor of feces
Her daughter tells you the woman has been
incontinent diarrhea for three days, her urine is
brown
The daughter has been caring for and cleaning her
mother, but there are no indications she used gloves
or masks
She called 9-1-1 because the patient became
unresponsive.
PPE: __ Gloves __ Mask __ Protective eyewear __ Gown
__ Pocket face mask/BVM
Drill of the Month
36
PPE Scenarios

The patient:
– A 21-year-old female auto crash victim
– Thrown through the windshield because she
was not wearing her seatbelt
– Multiple lacerations on her face, hands, arms,
torso, and thighs
– You also suspect intoxication because of the
odor of alcohol on her breath
– She says she has to throw up
PPE: __ Gloves __ Mask __ Protective eyewear __ Gown
__ Pocket face mask/BVM
Drill of the Month
37
PPE Scenarios

The patient:
– A child who jumped from a tree pretending to
be a super hero who could fly
– He appears to have a fractured right forearm
and fractured right ankle
– No apparent external bleeding except from is
gums where he knocked out two front teeth
PPE: __ Gloves __ Mask __ Protective eyewear __ Gown
__ Pocket face mask/BVM
Drill of the Month
38
PPE Scenarios

The patient:
– A 16-year-old teenager who cut his hand
while trying to slice a bagel while staying with
his grandparents
– The grandparents don’t have a car to drive
him to the hospital
– They immediately put wads of paper towels
on the wound and had him hold pressure and
elevate it until you arrived
PPE: __ Gloves __ Mask __ Protective eyewear __ Gown
__ Pocket face mask/BVM
Drill of the Month
39
PPE Scenarios

The patient:
–
–
–
–
–
–
A5-year-old boy bitten in the face by a neighbor’s dog
The dog is under the control of the owner; Animal
Control has been contacted
The mother is hysterical and is cradling her son in her
arms and has blood all over her
She has tried to clean and control the bleeding with a
cold, wet washcloth
The boy’s wounds are bleeding mildly
The child is calm but cowering in his mother’s arms
PPE: __ Gloves __ Mask __ Protective eyewear __ Gown
__ Pocket face mask/BVM
Drill of the Month
40
Why We Use Body Substance
Isolation Precautions
Student Performance Objective: Given information,
resources, and opportunity for discussion and practice:
– List and describe types of protective precautions.
– Define BSI precautions and explain their purpose,
importance, and requirements.
– List personal protective equipment and describe its
purpose.
– Demonstrate techniques for donning, doffing, and
disposing of PPE based on scenarios.
EMTs will follow acceptable Maryland medical practice and Maryland
Medical Protocols for Emergency Medical Providers.
Drill of the Month
41
Why We Use Body Substance
Isolation Precautions
Review:


List the types of protective precautions
– Isolation precautions
– Universal precautions
– BSI
– Standard
– Transmission
Why do you think it is necessary to know history of
protective precautions?
Drill of the Month
42
Why We Use Body Substance
Isolation Precautions
Review:
Why do you think you need to know in-hospital
precautions when you usually just drop patients at the
ED?
 What are the types of transmission precautions
– Airborne
– Droplet
– Contact

Drill of the Month
43
Why We Use Body Substance
Isolation Precautions
Review:
Describe the difference between airborne transmission
and droplet transmissions
– Describe the respiratory protection for each
 BSI precautions
– Define
– What is its significant purpose?
– What is the need and importance?
– What are the requirements of a BSI plan/program?

Drill of the Month
44
Why We Use Body Substance
Isolation Precautions
Review:
Personal Protective Equipment
– List PPE commonly used in BSI
– Describe the purpose or each piece of PPE
 Donning, Doffing, Disposing of PPE
– List PPE used for each scenario
– Explain why it was used (what protection it provided)

Drill of the Month
45
Why We Use Body Substance
Isolation Precautions
Review:
 BSI Precautions
 Personal Protective Equipment
 Donning, Doffing, and Disposing of PPE
Drill of the Month
46